A Cross-Sectional Survey to Evaluate the Influence of the COVID-19 Pandemic on Treatment Adherence in Chronic Dermatological Diseases

Abstract

Background: The COVID-19 pandemic and subsequent nationwide lockdowns have contributed to complex problems in the management of chronic dermatological diseases. Objectives: The objective of this study is to evaluate the impact of the COVID-19 pandemic on the management of chronic dermatological diseases treated with/without systemic immunomodulators and phototherapy. Materials and Methods: A single-center, cross-sectional, questionnaire-based survey via telephone calls/Google Forms was conducted from May 2020 to July 2020. Multivariate correlation analysis with adherence to treatment as dependent variable was performed to study the influence of various demographic variables, treatment-related factors, and pandemic issues. Results: Data of 138 patients (55% with psoriasis, 21% with vesiculobullous diseases, 18.2% with connective tissue diseases, and 5.8% with conditions such as alopecia areata, vitiligo, lichen planus, and reactive arthritis) were analyzed. The study population consisted of 81.1% of patients on systemic immunomodulators. Autonomous treatment modification was reported by 77% leading to poor disease control in 53.7%. There was a statistically significant negative correlation between income loss during the pandemic and treatment adherence. Duration of illness also showed a significant negative correlation, thereby indicating that treatment adherence reduced with disease chronicity. The highest nonadherence was noted with apremilast. None of the patients reported confirmed COVID infection. Conclusions: The study findings emphasize the direct and indirect effects of the COVID-19 pandemic on treatment adherence in chronic dermatological diseases. It underlines the need for better pandemic response by the development of patient education programs, standard protocols, and functional teledermatology units in Indian public health-care settings.